"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

June 27, 2017

The New Mexico Department of Health (NMDOH) is reporting two recent confirmed plague cases in 52-year-old and 62-year-old females from Santa Fe County. With the addition of these cases, there have been three human plague cases from Santa Fe County in 2017. All three cases required hospitalization. There have been no deaths from plague in 2017.

NMDOH conducted environmental investigations around the homes of the patients to look for ongoing risk and to ensure the safety of the immediate family and neighbors.

Plague is a bacterial disease of rodents and is generally transmitted to humans through the bites of infected fleas, but can also be transmitted by direct contact with infected animals, including rodents, wildlife and pets. Plague can be present in fleas that infest wild rodents in Santa Fe County, including the city limits of Santa Fe, and several other New Mexico counties.

“Pets that are allowed to roam and hunt can bring infected fleas from dead rodents back into the home, putting you and your children at risk,” said Dr. Paul Ettestad, public health veterinarian for the Department of Health. “Keeping your pets at home or on a leash and using an appropriate flea control product is important to protect you and your family.”

To prevent plague, the Department of Health also recommends:

• Talk to your veterinarian about using an appropriate flea control product on your pets as not all products are safe for cats, dogs, or your children.

• Clean up areas near the house where rodents could live, such as woodpiles, brush piles, junk and abandoned vehicles.

• Sick pets should be examined promptly by a veterinarian.

• See your doctor about any unexplained illness involving a sudden and high fever.

• Put hay, wood, and compost piles as far as possible from your home.

• Don’t leave your pet’s food and water where mice can get to it.

Symptoms of plague in humans include sudden onset of fever, chills, headache, and weakness. In most cases there is a painful swelling of the lymph node in the groin, armpit or neck areas. Plague symptoms in cats and dogs are fever, lethargy and loss of appetite. There may be a swelling in the lymph node under the jaw. With prompt diagnosis and appropriate antibiotic treatment, the fatality rate in people and pets can be greatly reduced. Physicians who suspect plague should promptly report to the Department of Health.

In New Mexico, there were four human plague cases in 2016 in Bernalillo, Mora and Rio Arriba counties with no fatalities; and four human plague cases in 2015 in Bernalillo and Santa Fe counties with one fatality.

Over 40 years ago, while visiting relatives in Taos, NM, I asked a local doctor if he saw any notable local diseases. "Plague," he replied at once, and then said it wasn't too serious since antibiotics (in that distant, pre-resistance era) would clear it up easily.

It wasn't until years later that I learned how plague turned up in the American Southwest: an outbreak in San Francisco's Chinatown in 1900 resulted in some victims escaping the city for Oakland and elsewhere, rather than be dealt with by racist white authorities and doctors. Plague quickly migrated to rats and squirrels on the east side of the bay, and it reached New Mexico before long.

For this we can thank the racist crooks and idiots then running San Francisco and the rest of the state. But, as Marilyn Chase wrote in her great 2003 book The Barbary Plague, the outbreak was also the start of the US public health service under Rupert Blue, a forgotten hero.

January 10, 2017

On 6 December 2016, the Ministry of Health (MoH) in Madagascar alerted WHO of a suspected plague outbreak in Befotaka district, Atsimo Atsinanana region in the south-eastern part of the country. The district is outside the area known to be endemic area in Madagascar. No plague cases have been reported in this area since 1950.

As of 27 December 2016, 62 cases (6 confirmed, 5 probable, 51 suspected) including 26 deaths (case fatality rate of 42%) have been reported in two adjacent districts in two neighbouring regions of the country. 28 cases, including 10 deaths have been reported from Befotaka District in Atsimo-Atsinanana Region and 34 cases including 16 deaths have been reported from Iakora district in Ihorombe Region.

Of the 11 samples tested, 5 were positive for plague on rapid diagnostic test and 6 are now confirmed at Institut Pasteur laboratory. Of the total reported cases, 5 are classified as pneumonic plague cases and the remaining as bubonic plague.

Retrospective investigations carried out in those two districts showed that it is possible that the outbreak might have started in mid-August 2016. The investigation in neighbouring villages is still ongoing. On 29 December, an investigation carried out within 25 km of the initial foci in Befotaka district has reported three deaths and is being investigated further for possible linkage to the outbreak.

The affected zone is located in a very remote and hard to reach and highly insecure area (classified as red zone due to local banditry). Despite arrangements made with the local authorities, insecurity slows down the investigations and response activities. In addition, a helicopter has been made available but its use has been limited due to bad weather and financial limitations.

Scientists at the Walter Reed Army Institute of Research (WRAIR) and the Walter Reed National Military Medical Center recently published a troubling finding: Escherichia coli carrying a gene conferring resistance to the antibiotic colistin in the urine of a Pennsylvania woman (McGann P et al. Antimicrob Agents Chemother. 2016;60[7]:4420-4421). It was the first time the gene, mcr-1, had been found in a human bacterial infection in the United States.

Mcr-1 thwarts colistin, a 1950s-era antibiotic called out of retirement to treat multidrug-resistant infections including carbapenem-resistant Enterobacteriaceae. Even more concerning, the gene is carried on a plasmid, a short, circular strand of nonchromosomal DNA that can transfer to other types of bacteria, spreading its potentially lethal resistance.

Scientists reported the discovery of the gene in China just last year (Liu YY et al. Lancet Infect Dis. 2016;16[2]:161-168). By then, it was already widespread in E coli and Klebsiella pneumoniae, two species of Enterobacteriaceae, found in a number of pigs and patients in South China. Enterobacteriaceae is a family of gram-negative bacteria that also includes Salmonella, Shigella, and Yersinia pestis (plague).

The gene has now been detected in livestock, meat, and people on most continents (Skov R, Monnet D. Euro Surveill. 2016;21[9]:1-6). In July, a second case of E coli with the mcr-1 gene was reported in a human patient in New York (Castanheira M et al. Antimicrob Agents Chemother. doi:10.1128/AAC.01267-16 [published online July 11, 2016]).

News of the superbug in US patients came as no surprise to Barbara E. Murray, MD, director of the division of infectious diseases at the University of Texas Health Science Center at Houston and an internationally recognized expert on antibiotic resistance.

“Once [resistance has] appeared somewhere, you know it’s going to appear other places, so it was just a matter of time,” said Murray, a past president of the Infectious Diseases Society of America. “I’ve been working on antibiotic resistance for 30 years, and it always happens [this way].”

Any year, there’s always some chance of a super-volcano erupting or an asteroid careening into the planet. Both would of course devastate the areas around ground zero—but they would also kick up dust into the atmosphere, blocking sunlight and sending global temperatures plunging. (Most climate scientists agree that the same phenomenon would follow any major nuclear exchange.)

Yet natural pandemics may pose the most serious risks of all. In fact, in the past two millennia, the only two events that experts can certify as global catastrophes of this scale were plagues. The Black Death of the 1340s felled more than 10 percent of the world population. Eight centuries prior, another epidemic of the Yersinia pestis bacterium—the “Great Plague of Justinian” in 541 and 542—killed between 25 and 33 million people, or between 13 and 17 percent of the global population at that time.

No event approached these totals in the 20th century. The twin wars did not come close: About 1 percent of the global population perished in the Great War, about 3 percent in World War II. Only the Spanish flu epidemic of the late 1910s, which killed between 2.5 and 5 percent of the world’s people, approached the medieval plagues. Farquhar said there’s some evidence that the First World War and Spanish influenza were the same catastrophic global event—but even then, the death toll only came to about 6 percent of humanity.

The report briefly explores other possible risks: a genetically engineered pandemic, geo-engineering gone awry, an all-seeing artificial intelligence. Unlike nuclear war or global warming, though, the report clarifies that these remain mostly notional threats, even as it cautions:

[N]early all of the most threatening global catastrophic risks were unforeseeable a few decades before they became apparent. Forty years before the discovery of the nuclear bomb, few could have predicted that nuclear weapons would come to be one of the leading global catastrophic risks. Immediately after the Second World War, few could have known that catastrophic climate change, biotechnology, and artificial intelligence would come to pose such a significant threat.

October 30, 2015

A teenage girl in Oregon has been hospitalized after contracting the bubonic plague, according to state officials.

The state department of health reported that the girl acquired the disease from a flea bite while on a hunting trip. She fell sick by October 21 and was hospitalized in Bend on October 24, where she remains in the hospital’s intensive care unit.

Plague is an extremely rare disease, though there has been more activity in the US than usual of late. Every year, the US records about a dozen plague deaths. According to the latest data from the Centers for Disease Control and Prevention, there were 11 cases and three deaths in six states in just five months, between April and August.

In Oregon, only eight human cases have been diagnosed since 1995, and no deaths have been reported.

October 23, 2015

The Bronze Age — between about 3000 and 1000 bc — was a tumultuous period that saw new cultural practices and weapon and transport technologies spread rapidly across Eurasia. Earlier this year, a pair of ancient-genome studies documented a massive exodus of people from the steppe of what is now Russia and Ukraine; they scattered west into Europe and east into central Asia.

“But we didn’t know what the cause of these quite sudden migrations was,” says Morten Allentoft, an evolutionary geneticist at the Natural History Museum of Denmark in Copenhagen, who was part of a team that sequenced DNA from 101 Bronze Age skeletons.

Suspecting that an infection similar to plague might have been involved, the same team analysed 89 billion fragments of raw DNA data from the Bronze Age skeletons in search of Y. pestis sequences. Teeth from 7 of the 101 individuals tested positive, and 2 contained enough plague DNA to generate complete genome sequences. The oldest of the Bronze Age plague strains came from an individual who lived nearly 5,000 years ago in southeast Russia, pushing back the origins of plague by some 3,000 years. The findings are published today in Cell.

Plague without fleas

The Bronze Age plague strains were very similar to the bacteria responsible for the Black Death and modern outbreaks. They shared nearly all of the ‘virulence genes’ that distinguish Y. pestis from a related, although much less deadly, bacterium that infects the intestines.

But the analysis revealed that plague might have been less transmissible in the early Bronze Age. The six oldest Bronze Age strains lacked a gene called ymt that helps Y. pestis to colonize the guts of fleas, which serve as an important intermediary. In outbreaks of bubonic plague, infected fleas (often travelling on rodents) transmit the bacteria to humans living nearby. Without fleas as a go-between, Y. pestis spreads much less efficiently through blood (where it is known as septicaemic plague) or saliva droplets (pneumonic plague). An early Iron Age skeleton from Armenia dated to around 1000 bc was infected with Y. pestis that harboured ymt as well as another mutation linked to flea-aided transmission.

Wyndham Lathem, a microbiologist at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois, says that in the absence of ymt, Bronze Age plague victims would have probably contracted pneumonic plague, as opposed to the bubonic form. All the Bronze Age strains also contained another virulence gene, pla, which Lathem's team has shown is important in infecting the lung.

Plague may have been less transmissible without fleas, but it would have been no less deadly. More than 90% of untreated cases of pneumonic plague are fatal.

September 12, 2015

The Centers for Disease Control and Prevention is expanding its investigation into possible mishandling and improper shipment by Defense Department laboratories of organisms that cause deadly diseases, including plague and encephalitis, U.S. officials said Thursday.

Concerns about the handling of those samples led the Army to announce a moratorium on production, shipping and handling of toxins at nine labs last week. But officials did not acknowledge until Thursday that plague and encephalitis samples were involved.

When asked why the Pentagon didn’t disclose the new concerns about plague and encephalitis last week, Pentagon press secretary Peter Cook said that officials were trying to be as forthcoming as possible “without alarming the public.”

He added that officials are waiting for the results of the investigation.

In a statement Thursday, the CDC said it was investigating four Defense Department labs as a result of spot checks at two facilities. The Army said the spot checks were at Edgewood Chemical and Biological Center and U.S. Army Medical Research Institute of Infectious Diseases, both in Maryland.

“CDC has identified a number of transfers of concern involving multiple organisms,” the CDC said, adding that the investigation is trying to determine whether there are record-keeping or quality-management problems or if there were shipment violations involving the toxins. “At this time, there is nothing to suggest risk to the health of workers or the general public.”

According to the CDC, most of the transfers were between Defense Department facilities. In a separate statement, the Army said the CDC raised questions about a particular organism that causes plague — known as Yersinia pestis — during an Aug. 17 inspection at Edgewood. The CDC questioned whether the organism was fully virulent, even though it was stored in an area designated for non-fully virulent materials.

Cook said he believes that a sample was in a freezer in a controlled setting but outside a containment area, and the CDC questioned whether it was an infectious form of plague.

The Army said that initial tests suggest the strain was not fully virulent, and the CDC is working to verify those tests.

“There is no indication that anyone has been exposed from handling this strain and no one has become sick,” the Army said, adding that the sample was immediately contained and properly stored.

In addition, the Army said the CDC questioned the labeling of a strain of equine encephalitis viruses, and whether it was properly handled.

September 07, 2015

The Ministry of Health of Madagascar has notified WHO of an outbreak of plague. The first case was identified on 17 August in a rural township in Moramanga district. The case passed away on 19 August. As of 30 August, 14 cases, including 10 deaths, were reported. All confirmed cases are of the pneumonic form. Since 27 August, no new cases have been reported from the affected or neighbouring districts.

Public health response

The national task force has been activated to manage the outbreak. With support from partners – including WHO and the Pasteur Institute of Madagascar – the government of Madagascar is implementing thorough public health measures, including active case and contact finding, provision of chemoprophylaxis, case and contact management, enhanced epidemiologic surveillance, infection prevention and control (house disinfection), vector control activities, social mobilization, coordination and resource mobilization.

WHO risk assessment

WHO does not recommend any travel or trade restriction based on the current information available. In urban areas, such as Antananarivo, the surveillance of epidemic risk indicators is highly recommended for the implementation of preventive vector control activities.

August 27, 2015

Madagascar ranks second after the Democratic Republic of Congo and Zambia before. It is not the FIFA rankings, but this rather gloomy established by an American researcher on the most affected countries by the resurgence of the plague.

Fever then!

WHO regards it as a re-emerging disease in the world. Even in the Big Island where his resurgence in the Moramanga region feeds back the collective imagination which assimilates to a plague, even though the disease - still as dangerous and contagious - not decimating populations as it was if in medieval times. She was also described as a "disease of the Middle Ages" and above all touched (the world) the beggars and the needy.

Today, it is and remains "the disease of the poor". It decimates them without reducing poverty. With its share of unhealthy and unhygienic, a breeding ground for the bacteria of the plague spread by rats - and their chips - invading slums and garbage mountains. Promiscuity also promotes disease that is spread by close contact with a person or an infected animal.

This raises the question of sanitary surveillance of relatives of victims of the plague in Moramanga where self-medication in high doses of Cotrim, somehow the antibiotic of the poor, has not visibly decreased the fatality rate since the number rose again from the dead. Which may wake up to rightly or wrongly, in the company's self-preservation or almost natural reflex is to put in quarantine, relatives of patients and / or victims which would then avoid like ... plague.

A disease that reappears every year in the territory, although it is early this time because usually, the re-emergence occurs during the rainy season. Anyway, even in advanced countries like the United States have not been able to completely eradicate the plague.